Million-dollar industry payments to doctors go undisclosed

By gerencherk

If your surgeon is earning seven-figure payments from the use of an implant he’s recommending for you, chances are you’d want to know that before heading down his prescribed path. But nearly half of doctors who made at least $1 million in corporate payments didn’t have that relationship described in their published scientific papers. That’s according to a new study out this week in the Archives of Internal Medicine, which tracked physician payments made by five of the top orthopedic-device companies in 2007 and compared them to 95 published articles.

Medical journals try to police potential conflict-of-interest problems by requiring financial disclosure from their authors, but the standards are typically vague, the report found. It’s often up to the doctor to determine whether and how to disclose industry funding in their articles, and even when they do, journal editors rarely demand proof or consult multiple databases to verify the information is correct, said David Rothman, president of the Institute on Medicine as a Profession at Columbia University and an author of the report.

Collectively, the five manufacturers the study examined — Stryker, Zimmer, Biomet, DePuy Orthopedics and Smith & Nephew — made more than 1,650 direct physician payments worth about $248 million in 2007.

Forty-one individuals (38 physicians and two non-physician researchers) accepted between $1 million and $8 million from orthopedic device manufacturers in 2007 for a total of $114 million, the study found. A year later, 32 of them published a total of 151 articles related to orthopedics from January 2008 to January 2009. Fewer than half of the total 95 articles by authors earning at least $1 million that were studied made mention of a financial relationship between the physician and the device company that paid him or her. And only seven of the 95 articles disclosed any information on the amount of money the doctor received.

Rothman and his colleagues argued that readers need to know when significant amounts of money change hands in the form of consulting fees, royalties and other payments so they can make informed decisions about a doctor’s conclusions in an article.

“These articles constitute a permanent scientific record that is used by practicing physicians, guideline committees, purchasers and patients to evaluate treatment options,” the authors wrote. “Journal editors, reviewers and readers must be fully informed about authors’ industry relationships to consider the potential for bias.”

If bias is suspected, hospitals and medical centers need to take a hard look at whether to keep a doctor with a history of substantial company payments on committees that review the purchase of drugs and medical devices, Rothman said.

“My hope is that with greater disclosure we’re going to have better management and when necessary, appropriate disqualification,” he said. “What you might find is enhanced scientific integrity and maybe better performance in the best interest of the patient.”

Today, it’s not that easy to track down disclosures related to doctor payments on individual companies’ websites. The study found 15 drug and device manufacturers are doing it, and a handful of device makers had to set up Internet listings as part of a settlement with the U.S. Department of Justice. But in 2013, the health-reform law will require greater transparency. Starting that year, all drug and device makers will have to report all physician payments worth more than $10 in a central database that is publicly available and searchable, Rothman said.

“We wanted journal editors, deans and professional medical society officers to get much more alert to and involved with the new data even before 2013,” he said. “There’s data out there. Spot check. Let it be known you’re going to spot check. People do behave better when they’re watched.”

What’s more, patients should remember that questioning their doctor about potential conflicts of interest, in addition to a particular device’s or procedure’s risks and benefits, can be good preventive medicine.

“You might want to ask your surgeon, ‘Is this the best hip for me or the best hip for you?’” Rothman said. “And you always do have recourse — not only to the web but to a second opinion.”

About Health Matters

Health Matters is a blog-style round-up of news and analysis concerning consumer health and the business of health care. The lead writer is MarketWatch reporter Kristen Gerencher, who also writes the Vital Signs column. Andrea Coombes and Jonathan Burton contribute editing. Gerencher won a 2006 explanatory journalism award from the Society of Professional Journalists-Northern California for a series she did on health savings accounts.